General Treatment Options for Fractures

Question 1

What are the aims of non surgical management? (3)

Answer 1

• Stability to keep bones aligned
• minimise movement (cage rest)
• Analgesia

Question 2

Which fractures do you think are suitable for conservative treatment? (5)

Answer 2

Flat bones/axial skeleton

Selected fractures of:
= Pelvis
= Mandible
= Spine
= Scapula (non-articular).

Question 3

Generically speaking; what is suitable for conservative # management? (3)

Answer 3

• Minimally displaced
• Cancellous bone
• non load bearing bone

Question 4

Which fractures do you think are suitable for external coaptation anatomically?

Answer 4

Below elbow/stifle

Question 5

Which fractures do you think are suitable for external coaptation anatomically; # types? (4)

Answer 5

• Young
• Minimal displacement
• 1 bone of a 2 bone area
• stable #

Question 6

Advantages of non surgical management? (5)

Answer 6

No/short anaesthesia

No open surgery

No disruption of soft callus

Cheaper materials

Cheaper? (Not always cheaper overall).

Question 7

Disadvantages of non surgical management? (5)

Answer 7

Insufficient stability leading to delayed or non-union

Malunion

Poor functional outcome

Complications

Cast sores.

Question 8

Advantages of surgical management? (4)

Answer 8

Prerequisite for bone healing

Providing the necessary stability to promote healing

Faster return to function

Aiming for an optimal functional outcome.

Question 9

Disadvantages of surgical management (4)

Answer 9

Complications

Insufficient stability leading to delayed union or non-union

Malunion

Poor functional outcome.

Question 10

What are the2 types of bone healing?

Answer 10

Primary
Secondary

Question 11

When does 1ry bone healing occur?

Answer 11

Occurs when there is precise reduction of the fracture and the two bone ends are directly aligned.

Question 12

1ry bone healing:

The perfect alignment of the fracture ends allows A) to form, B) resorb bone on either side of the fracture line, and this is followed by bone formation, ultimately leading to reformation of C)

Answer 12

A) cutting cones
B) osteoclasts
C) cortical osteons.

Question 13

Despite adequate internal fixation, in practice, there is often a small gap between the fracture ends and this is initially in-filled with WHAT? followed by osteoclastic bone remodelling and reestablishment of osteons, a repair process known as gap healing.

Answer 13

Woven bone

Question 14

What are the 3 stages of secondary bone healing?

Answer 14

1. Haematoma formation and acute inflammation
2. Reparative phase with soft callus and, subsequently, hard callus formation
3. Remodelling and modelling phase, whereby bone may eventually return to its original form.

Question 15

Define salvage procedure.

Answer 15

Salvage is “the act of saving something (such as a building, a ship, or cargo) that is in danger of being completely destroyed” or “to remove (something) from a place so that it will not be damaged, destroyed, or lost.”

A salvage procedure is considered a last resort and generally cannot be reversed.

Question 16

What ABx with open #, should we C+S?

Answer 16

Start an I.V. broad spectrum antibiotic. Note that routine bacterial culturing of acute wounds is not likely to help predict subsequent wound infection, nor is it likely to accurately guide early selection of antimicrobials to treat wounds that become infected.

Question 17

How to flush open # wound?

Answer 17

Gross contamination can be rinsed off with tap water, then switch to sterile Hartmann’s.

Question 18

What is normally an adequate first dressing?

Answer 18

Wet-dry

Question 19

What nursing care needs to be ensured with open # management? (4)

Answer 19

Incision needs to be frequently checked

Ensure adequate urination and defecation

Bedding needs to be soft, and the patient needs to be turned regularly

Exercise is restricted until the fractures are healed.